Can Marijuana Relieve Pain?

MarijuanaThere is currently a raging controversy about legalizing marijuana, especially for medicinal purposes.  A few states have recently legalized it, and several other states (including Minnesota) are considering it. This article will examine the potential benefits of marijuana for managing pain.

Marijuana Compounds & Ingredients

The active ingredients in marijuana are cannaboids, and there are at least 84 different ones present in the plant.  There are also 483 known compounds in marijuana.  The main compound is THC, which has psychoactive components.  For medical purposes, it has been used and approved for glaucoma and poor appetite related to chemotherapy and cancer.  Unfortunately, there are claims about the success of the plant for many other conditions, but very little scientific support to determine the reality of these claims.

Studies have shown that marijuana has psychoactive effects, some positive, and some negative. A few of the more common effects include:

  • Heightened mood
  • Relaxation, and euphoria
  • Decreased short-term memory
  • Impaired motor skills and judgment
  • Anxiety and paranoia

Marijuana & Pain

Marijuana has been known to have some impact on pain. Some studies show its effectiveness in managing nerve pain such as:

Why it works it not understood, but there are multiple areas in pain pathways that it may modulate.

The Need for Better Research

The problem with marijuana is that there are many compounds in the plant when taken as a whole.  Some of the chemicals may be beneficial, while others may cause problems.  On a scientific basis, most medical doctors want to know the specific compounds that are effective for any condition and use just that compound.  Marijuana has 483 different compounds and at least 84 cannaboids, and the whole plant is on the “Black List” – thought to be dangerous to society.  In the United States, research on marijuana is strictly controlled.  The variety of plants grown is extremely limited by the U.S. government and the restrictions on handling the plant make good research extremely difficult.

In reality, it is likely that there are beneficial cannaboids for a variety of painful conditions.  Good research is needed to determine which compounds are effective for what conditions.  The U.S. government needs to at least legalize marijuana for medical research, and get serious about determining the real safety issues with the various compounds.  Control of marijuana for safety versus making it illegal on all fronts is wise.

Heroin & Pain Medication: The Problem with Overprescribing

heroinThe number of heroin-related deaths has drastically increased over the last several years in Minnesota and across the nation. In the past, heroin was a drug in the shadows, shot up into veins for an immediate high.  It was a problem in the 1960’s and early 1970’s and then faded away for a while.  Today, it is back with a vengeance, and its resurgence is linked to prescription pain medications.

Heroin & Prescription Drugs

Today heroin is more pure than ever and is relatively cheap at small amounts.  The street cost of heroin is often less than that of prescription narcotics.  The availability of both heroin and prescription narcotics has led to our current crisis.  When prescription drugs are not available, people turn to heroin to obtain the high they need to prevent narcotic withdrawal.  Unfortunately, overdosing on heroin is easy.

A heroin addiction often begins with prescription opioids or narcotics.  These medications can be legitimately used to treat pain, but they have become overly prescribed and not closely monitored by physicians.  Many people are not controlling the medications they receive and are selling them for personal profit.  The movement of prescription opioids to the street, and the use of these medications for a high is now a major problem.

Pain Cannot be Cured by a Magic Pill

Patients today often think that medicine has a magical solution to their pain and that they are entitled to opioid pain medications.  There are many treatments for pain, but there is no magical pill that will resolve a person’s pain entirely. In the United States, we prescribe over 90% of all opioids in the world – surely we do not have that much more pain.

At one time, pain was undertreated and ignored by medication.  Education and awareness over time improved treatment, but the pendulum has swung past the rational treatment of pain.  Opioid medication has become the simple and easy treatment option for those in pain. But pain medicine is a complex specialty aimed at an appropriate management of the problem.  Good pain management is a comprehensive treatment, not an opioid pill.

The Solution is Proper Pain Management

Heroin and opioid drug abuse are now significantly intertwined.  Addiction is a disease that does not go away. Once a person has an issue with addiction, no matter what the drug, they will always be prone to addiction to other compounds.

Addiction is a serious problem, and treatment of pain is much more than treatment with opioids.  To decrease drug abuse across the country, physicians need to use pain management experts to develop good treatment programs for pain beyond just a pill.

When to Seek Medical Attention for Abdominal Pain

abdominal painAbdominal pain is fairly common and is usually not cause for alarm. Every structure in the abdomen can cause pain, including:

  • Stomach
  • Intestines
  • Liver
  • Spleen
  • Kidneys
  • Bladder
  • Appendix
  • Sexual organs
  • Blood vessels
  • Muscles

Since every organ and structure tends to have some type of sensory innervation, they can all be sources of pain.

Almost everyone has experienced pain from the stomach and intestines.  From overeating, to acid reflux and indigestion, to constipation or diarrhea, the problems are common.  Most of these issues are short lived, inconvenient, and not serious.  When they are intense and do not resolve quickly, sometimes they do require medical intervention.

When to Seek Medical Help

The main concern with abdominal pain is when to seek medical attention to help determine the cause.  Signs that indicate a need for further attention include:

  • Fever
  • Inability to eat or drink fluids for over a day
  • Ongoing vomiting
  • Vomiting blood
  • Severely painful abdomen and not being able to touch it
  • Painful urination
  • Passing blood in urine or stools
  • Difficulty breathing due to pain
  • Acute traumatic injury

Since there are so many different organs and structures linked to the abdomen, diagnosing the cause of pain may be difficult.  The starting point is always the history and story provided by the patient. A physical exam gives the next set of information.  With this basic information, the clinician then can determine the best tests to help find the answers to the cause of the pain.  Tests may include blood and urine analysis, X-rays, CT scans, ultrasounds, and sometimes invasive scopes of various systems.

Treating Abdominal Pain

Treatment options for abdominal pain are as variable as the causes.  Since the vast majority of causes are not life threatening, treatment is often simple.  Serious problems often require the intervention of medical specialists to guide the evaluation and treatment.  Self-diagnosis and treatment for minor problems is fine.  But when the symptoms are more serious, find a medical specialist who you can trust.  If looking up information on the Internet, stick to respected medical sites like WebMD, Mayo Clinic, and the NIH (National Institutes of Health).  Do not panic about information you read on the Internet but use it to discuss concerns with your provider.

Can Antidepressants Relieve Pain?

antidepressantsPain and depression are closely linked in the brain, and medications used in depression can be helpful in the controlling pain.  Some antidepressants directly impact pain, while others only affect depression.

Antidepressants are most helpful in treating pain caused by damage to nerves or by an overactive nervous system (aka neuropathic pain).  Specifically, antidepressant medications can help treat the following painful conditions:

Acute injury and surgical pain may be helped, but is still being studied.

Types of Antidepressants

There are two types of antidepressant medications that are used to control neuropathic pain:

  1. Tri-cyclic antidepressants (TCAs), such as amitriptyline, Nortriptyline, and desipramine
  2. Serotonin/noradrenaline reuptake inhibitors (SNRIs) such as Cymbalta and Savella

Antidepressants such as Zoloft, Prozac, Celexa, and Effexor have no affect on pain.  These medications decrease nerve transmission and nerve sensitivity. The TCAs have many side affects including dry mouth, low blood pressure, sedation, and urinary problems.  The newer SNRIs have very few side affects.  Cymbalta is very effective in a number of neuropathic pain situations including diabetes, radiculopathy, and fibromyalgia, while Savella only is known to work in fibromyalgia.

Pain & Depression are Closely Linked

The nerve fibers that transmit pain sensation travel through the brain in the same regions that process emotional signals.  These regions actually interact with each other.  Stimulating depression centers can increase the perception of pain.  When depression is not controlled, and a patient does have pain, rarely will the pain be controlled no matter what the treatment.  Therefore, treating depression is often essential in effectively treating pain.  Many people do not want to admit that they might be depressed, and thus not treating the depression does affect the pain level perceived.

Pain and depression in the brain are closely linked.  Neuropathic pain is often treated with a variety of medications, many of which are antidepressants.  Pain itself can change a person’s function and activity level, and cause depression.  Treating the concomitant depression that pain may cause does help manage the severity of pain in many patients.  Some medications treat both pain and depression, others may only treat depression, treating both together is often very effective in controlling pain.

Can Genetic Switches Turn Off Pain?

twinsA recent article published in Forbes this month describes research in England that found a connection between DNA and perceived pain levels.

The Study

The study tested perceptions of pain across 1,000 identical twins. Researchers attached a heat source to each twin’s arm and began to increase the heat, telling each participant to press a button when the heat became too much to handle.

The results of the study showed that many of the twins did not have identical perceptions of pain.  Researchers then took blood samples from a select group of twins in which the differences in pain perception were highest. From these blood samples, researchers found several segments of DNA that appeared to be different between the twins.

As most studies go, this is interesting but it’s a relatively weak finding, all things considered.  Pain is far more complex than this study makes it out to be. As a result, this study really does not show anything useful.

Pain Perception is based on Emotional Experiences

Pain is an emotional response to perceived sensory changes.  Identical twins have the same genetic make-up, but they do not have the same life or emotional experiences and therefore will likely have different perceptions of pain.  Analyzing the differences in genetics between two twins and postulating that these contribute to differences in perceived pain is highly unlikely.  The most likely explanation of the difference in pain perception is the difference in life experiences.  There clearly was no control of these variables and this is well known to have a significant effect in pain perception.

Unfortunately, this is only an interesting side light of a story on pain.  When the most important variables that impact pain perception have no control, no conclusion can possibly be accurate beyond the wildest of guesses for the results.  Bottom line, this makes for an interesting story and nothing more.